A Pilot/ Feasibility Study Comparing Response Rates of Intra-arterial and Intravenous Cisplatin Chemotherapy, Combined With Radiation, in Patients With Locally Advanced Carcinoma of the Oral Cavity and Oropharynx
Head and neck malignancies represent a group of epithelial tumors that arise from the oral
cavity, pharynx, and larynx and account for about 3 to 5% of all cancers in the United
States. In 2010, an estimated 49,260 people (35,530 men and 13,730 women) will develop head
and neck cancer, and an estimated 11,480 deaths (8,300 men and 3,180 women) will occur.
Three modalities of therapy have established roles in the treatment of carcinoma of the head
and neck: chemotherapy, radiation therapy, and surgery. The choice of modality depends upon
many factors such as the site and extent of the primary lesion, the likelihood of complete
surgical resection, the presence of lymph node metastases, etc. Traditionally, smaller
lesions (stage T1-T2) are effectively treated either, by surgical excision or irradiation
whereas more advanced disease (T3-T4) is treated with combined surgery and radiation or
chemoradiation. The goal of concurrent chemotherapy with radiation is to increase
locoregional control and prevent distant metastases.
A specific concomitant chemoradiation protocol for head and neck cancer known as RADPLAT
employs the pharmacologic principles and techniques described above. Capitalizing on the
cisplatin-neutralizing agent sodium thiosulfate and its pharmacokinetic properties, enormous
concentrations of cisplatin can be infused directly into large head and neck tumors through
a targeted IA approach. In a Phase I study, it was determined that cisplatin could be safely
administered to patients with advanced and recurrent head and neck cancer at a dose
intensity of 150mg/m2/week.
The patient must be considered a clinical candidate for either intra-arterial or intravenous
administration of cisplatin to be eligible for the study. Once enrolled and registered on
the study, the subject will be randomized to either intravenous or intra-arterial
administered cisplatin. Subjects will be assigned in a 1:1 ratio of intra-arterial versus
intravenous administration. All patients will receive concurrent radiation therapy. Standard
institutional practice will be applied for dose reduction and treatment of radiation therapy
related toxicities.
A combination of lateral opposing fields will be used for the treatment of the primary tumor
site and upper neck when three dimensional CRT is used and is not applicable for IMRT. A
single anterior A-P field can be used to treat the lower neck below the primary tumor/upper
neck. When there are positive nodes in the lower neck, an additional posterior field may be
necessary to deliver a supplemental dose to the positive nodes. All fields must be treated
on each treatment session.
The investigators will measure feasibility of the study protocol through enrollment and
screen failure data. The study will test the hypothesis that intra-arterial cisplatin is
more effective for patient outcomes in overall survival, disease free survival, cancer
specific survival, rate of local and regional control of cancer, site of recurrence, organ
preservation rate, toxicity, and correlative specimen availability.
Interventional
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
number of enrolled subjects
enrollment
2 years
No
K. Thomas Robbins, MD
Principal Investigator
Southern Illinois University School of Medicine
United States: Institutional Review Board
ROB-SCI 12-001
NCT01587820
June 2012
December 2017
Name | Location |
---|---|
Southern Illinois University School of Medicine | Springfield, Illinois 62794-9658 |
Simmons Cancer Institute at SIU School of Medicine | Springfield, Illinois 62702 |